On October 1, 2016, new International Classification of Diseases (ICD)-10-CM and ICD-10-PCS code sets went into effect. Updating of these codes traditionally occurs on an annual basis, however, during the immediate years leading up to the ICD-9 to ICD-10 transition there was an extended freeze to code updates to support a smooth transition. Therefore, for fiscal year (FY) 2017, updates and revisions include changes since the last completed update (October 1, 2013). As a result of the consolidated coding updates, a large number of new codes were added or removed from the ICD-10 code set. The Centers for Medicare & Medicaid Services (CMS) is acutely aware of the relationship between the ICD-10 update and quality reporting. Under the Physician Quality Reporting System (PQRS), calendar year (CY) 2016 is the performance period for (1) the 2018 PQRS and Value Modifier payment adjustments and (2) for eligible professionals (EPs) who were part of a Shared Savings Program ACO participant TIN in 2015 and are reporting outside their accountable care organization (ACO) for the special secondary reporting period, because their ACO failed to report on their behalf for the 2015 PQRS performance period. CMS has examined impact to quality measures and has determined that the ICD-10 code updates will impact CMS’s ability to process data reported on certain quality measures for the 4th quarter of CY 2016. Therefore, CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any EP or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016. The Value Modifier program will consider solo practitioners and groups, as identified by their taxpayer identification number (TIN), who meet reporting requirements in order to avoid the PQRS payment adjustment (either as a group or by having at least 50% of the individual eligible professionals in the TIN avoid the PQRS adjustment) to be “Category 1,” meaning they will not incur the automatic downward adjustment under the Value Modifier program. Consistent with previously communicated eCQM reporting requirements, eligible professionals must submit eCQM data corresponding to the 2015 versions of the measure specifications and value sets (2015 Annual Update) for 4th quarter 2016 reporting. For the 2017 performance period, CMS will publish an addendum containing updates relevant to the ICD-10 value sets for eCQMs in the Merit-based Incentive Payment System Program (MIPS). CMS will provide additional information on the addendum later this year.

To Whom It May Concern:   The annual ICD-10 code update that recently occurred on 10/1/2016 caused certain code values to become non-billable and introduced other new code values as billable. Some examples are:   - E10.321, Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, is no longer a billable code. - E10.3211, Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye, is a new billable code. - H40.11X1, Primary open-angle glaucoma, mild stage, is no longer a billable code. - H40.1111, Primary open-angle glaucoma, right eye, mild stage, is a new billable code.   We do not allow non-billable codes to be used in our EHR. So for exams after 10/1/2016, providers cannot use codes such as "E10.321" or "H40.11X1" for diagnosis but instead must use billable codes such as "E10.3211" or "H40.1111".   Currently, the value sets used by the CQMs support the older, non-billable codes but do not yet support the newer, billable codes.   So a problem arises going forward with respect to CQMs. When a diagnosis is coded using the new, billable codes, then these codes won't match codes in the existing CQM value sets. Which means certain conditions of the CQM won't be met.   For example, CMS 143/NQF 86 "Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation" uses value set oid 2.16.840.1.113883.3.526.3.326 "Diagnosis, Active: Primary Open Angle Glaucoma (POAG)" but this value set does not contain "H40.1111".   Likewise, CMS 167/NQF 88 "Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy" uses "Diagnosis, Active: Diabetic Retinopathy using Diabetic Retinopathy Grouping Value Set (2.16.840.1.113883.3.526.3.327)" but this value set does not contain "E10.3211".   Are there any plans to update the CQM value sets so that the newer ICD-10 codes will be supported?